9905-128 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
0 W Professionals Code, and my License is in full force and effect.
O=)ch License # Lic. Class Ex . Date
F -_L
1 1684 13 f Oi
Z r- ¢are- Signature of Contractor
CD
ti I—� OWNER -BUILDER DECLARATION
HW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z_ (,) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). .011
( ) I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
Cn
Z WORKER'S COMPENSATION DECLARATION
CL
2 Z I hereby affirm under penalty of perjury one of the following declarations:
n � 0 () 1 have and will maintain a certificate of consent to self -insure for workers'
< LLj LL_ compensation, as provided' for by Section 3700 of the Labor Code, for the
� Q
performance of the work for which this permit is issued.
n Q () ( 491,have and will maintain workers' compensation insurance, as required by
c) Q SeEfion 3700 of the Labor Code, for the performance of the work for which this
L rn I— permit is issued. My workers' compensation insurance carrier & policy no. are:
? Z Carrier Policy No.
Cb 5
r d
Th Mt, �j���ttica a � -9
J (This section n of bcompleted if the permit valuation i or $100.10 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
1I. subject to the workers' compensation{ provisions of Se tion 3700 of the Labor
Code, I shall forthwith comply with th a provisions.
D te: %� ✓� Applicant fit 4C —
arning Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation,' damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and rtrestrictions set forth on his
application.44 ,.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to.,
any permit issued as a result of this applicaton agrees to, & shall, indemnify e
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation. ,
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned propertfor inspection
}pur oses,.
y8ignature (Owner/Agent) ✓ ,Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9905,128 TRACT
06/10/199 S".646.20 22� 2399.5-4
JOB SITE
APN
ADDRESS
45-170 HiRC C`PiF14T CIRC li'.
6414-0441-1121
OWNER - CONTRACTOR/DESIGNER/ENGINEER
[NCO 1101VIES CORP. 1Nt`;O HOMES CORP.
1282 WV ARROW kiWY 1282 W. ARROW H'iVY
UPLAND CA 91785 UPLAND C.A. 9178.5
f409)913f.-8989 CBLf6 3318
USE OF PERMIT
". i 9
iv vf.i la
,.r ��. � '.,iV4.f
5'1+`1) - PLAN 1B, LOT'22, - PRPMT LiOhS NUi iNC'i.ME MOCK WAa..LS
OR POOL.
`i TACT CONSTf11.t TION 1,411,00 SH
PORCWPAe10 141.01 SP
GARAGFaY::ARPOR.T 416.(14) 5
9�,,�UAIA'C11: D COST OF CONST R.UCTION
86,646.20
PERMIT FEE S+L1.NIAIAl} V
CON13TRidMOly FFE 101-000-1418-000 $581.00
:PLAN CHECK FEE 101-000-439-318 �oyU.72
iLfFC`RANI[C;AL FEE .101-000-421-000 147.0111
ELEG1'R.ICAL NEE 101.000-4.20-000
Pl',UNIBINGt.FEF 101-000-419-000 �� S1,1R.Ct0
STRONG A40TION FEE - RESID t01-000-241000
GRADIWO r'EE .101-1300-423-000 1;20.00
MFP.A59'R1,1C`.TURF "taE1 225-000-443-342 $1,f�i}7.33
• �! R�'6R T
� t
Si.Cii- WAL CO-NSTRUCTION PLAN' CH CK
$3,308.94
j LESS PRT, -.PAID i'.8 FS
$0.00
JUN 1.0 1000 TQ1tL PERN T FEES DUE NOW
S3,308.94
RECEIPT
DATE 4;
iBYf
I D T�FI ALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
l
Exhaust Fans
OX to Wrap
'10—R-2 Q
F.A.U.
Framing
l;!_:
Compressor
Insulation
c. /
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
p
Drywall - Int. Lath
n—Zz g a
Final
Final z• 2 a► •
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
4 1
Encapsulation
Gas Piping
Gas Test 77-77-1
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 0 27
Utility Notice (Perm)
COMMENTS:
NOV-19-99 FRI 11:49 WESTERN INSULATION FAX NO. 9096868786
WES'T'ERN INSULA T'IONt INC.
4211 Tatham 9tmet, Riverside, CaU bmia 93501
(909) 686.8760
(909( 686.8786 Sax
t INSULATION .CERTIFfCA►TE
P. 17
THIS 15 TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE
CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24, STATE OF
CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/ PHASE: DESERT PRIDE -PHASE 4 B TRACT #:23995-4
LOT#: 22 PLAN 1
' SITE ADDRESS: 45-170 BIRCHBREST CIRCLE, LA QUINTA; CA.
E 1ERIOR_WALLS:
MANUFACTURER: JOHNS -MANVILLE -fHICKNESS: 3 5/8 R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: GREENSTONE THICKNESS: 10.3" R -VALUE: R-38
GENERAL CONTRACTOR
LICENSE NUMBER -
BY: UMBER:
BY:
TITLE:
DATE:
AMERICAN COMPANY
_ NS IATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PVoductloa Ma ager
DATE: NOVEMBER 19,1999